Implementation of an Electronic Health Record

Transcription

1 Implementation of an Electronic Health Record Mark Ficker Vice President, Medical Group Services & Chief Financial Officer

2 Brown & Toland Overview

3 Mission Brown Leading & Toland organization Medical Group is a leading of organization of community and academic physicians. community We are committed and academic to providing superior, coordinated and comprehensive medical physicians services. Owned and governed by physicians, we provide Owned and governed excellent healthcare, product choice, and value to by physicians our patients through clinical integration, innovation, and technology. Community Physician

4 Brown & Toland Medical Group IPA with 195,000 Members 1,500 Physicians Product Offerings & Services Financial Health Northern California Health Care Marketplace

5 Key Business Objectives Enhance Clinical Integration: Continue to develop processes and systems to clinically integrate care across the BTMG physician network. Health Improvement and Quality Improvement: Continue to promote clinically integrated, comprehensive patient health care through health improvement and quality improvement programs. Organizational Cost Reductions: Reduce organizational cost through improving the quality of patient care delivered and by continuing to implement administrative efficiencies. Network Diversification and Product Administration: Provide a comprehensive, cost effective, high quality network of health care and administrative services for all competitive medical benefit plan models. - Claims administration & eligibility - Customer service - Care management - Quality improvement -Finance - Data Warehouse & DSS - Physician Office Services - Network Management - Product Development -Information Technology -Human Resources - RX Management Develop disease management programs Develop an outcomes measurement program Improving health in the community Recognize, reward & assist high quality, efficient, & effective physician practices Improve physician office staff education programs Physician Services: Provide administrative and point of care services that will efficiently manage the physician s practice and enhance the overall quality of care provided. Regulatory Compliance: Continue to comply with all regulatory requirements.

6 Building a Strong Foundation

7 Internet Member view of clinical record Personal disease management Self help General Health Information Brown & Toland Medical Group Characteristics Patient Education Ancillary Services Lab Radiology Pharmacy PT Administration Eligibility Management Care Management Claims processing Capitation management General financials Decision support Case management Concurrent review Wellness management Preventive management Disease management Patient Intervention Patient Advocacy Customer service PCP assignment Demand management Credentialing Protocols Pathways Medical policies Practice guidelines Clinical decision support Alerts & Reminders Journals Medical Knowledge Population Management Outcomes Best practices Research Research & Education Medical Delivery Patient Access Primary care Specialty consulting Acute Post acute Scheduling Online Nurse advice Physician access eoffice Visits Rx Renewals Core Medical Group Characteristics Patient centric Accessible services Patient & MD is known to system Care & care management is coordinated across the continuum Clinical & administrative data is accessible enterprise-wide Consolidated financial processes Enterprise-wide reporting with feedback loops Support for wellness and knowledge transfer to patient

8 Staged IT Strategy: Operational Efficiency & Regulatory Risk Assessment IDX Optimization & Data Quality RACER Replacement Data Warehouse/Data Marts InterQual Implementation Web Foundations Portal Development & earchitecture HIPAA Risk Assessment Disaster Recovery Planning Help Desk Differentiate HIPAA Remediation Web EMR Options Analysis & System Selection Clinical Protocols & Alerts Physician/Patient Connectivity Decision Support Reporting Medical/Disease Management Programs Evaluate CRM Options Expanded Network Services End User Device Standards Remote Access Control Operational Improvements Transformation Physician Services Integrated PMS & EMR All Product Offering Sustainability and Competitive Advantage $8 Million $10-12 Million

9 Foundation for IT Success IT success depends on establishing a solid foundation to enable strategies and deliver expected outcomes & benefits Reliable Information Management User Benefits Applications Systems Integration & Control Durable Infrastructure and Sound Standards User focus is typically at the surface & on their own expected benefits How well systems provide these benefits depends upon a solid, below the surface foundation Appropriate IT Leadership, Skills, and Staffing Levels Senior Management Support, Joint-Ownership, and Communication of IT Strategic Vision and Plans Business Unit-wide Synchronization of Business Plans, Processes and Systems Clear and Sound Corporate Strategic Direction Shared IT Vision and Road Map Appropriate Context and Confidence

10 Physician Practice Solutions Strategy Business Needs

11 Operational Reality Enhanced Business Performance Increased Collections Reduced Expenses Studies have shown that up to 70% of potential business performance improvements are driven by changes to organizational workflow on the "front end," or patient access component, of the revenue cycle. Improved Patient Satisfaction Daily operations are not allowing physicians to focus all their attention on what they do best Treating patients

12 Goals of the Services Clinical Solutions Information About Patients Information About Care Administrative Solutions

13 Nothing will ever be attempted if all possible objections must first be overcome. first be overcome. Samuel Johnson

14 The Brown & Toland View

15 Provide Greater Efficiency to Physician Groups Patient Eligibility & Benefit Plan Verification Direct Claims Submission & Contract Rate Verification Reconcile Patient Schedule with Charge Capture Increase Coding Accuracy Increase turnaround time for authorizations and Referrals - Rules Integrated Decrease Charting Time & Eliminate Dictation Cost Reduce Office Labor Decrease Record Storage

16 Network Efficiency & Cost Savings Patient Information Available at the Point of Care Network Diagnostic Results Reporting & Shared Data between Primary Care & Specialty Care Eliminate Unnecessary Duplication of Diagnostic Testing Increase Efficiency of Referrals and Authorizations Improve Patient & Physician Satisfaction Reduce Medical Errors

17 The Physician s s Input Focus Group Discussions and Interview Results

18 Interview Themes Large demand for billing services this will be a quick win with the physicians Critical to articulate the preferred cost structure and specific benefits to be gained by optioning BTMG s s services EMR is essential to recruit younger physicians but will be resisted by older physician population that is less computer savvy Will need ability to deploy EMR modularly due to variances in adoption and practice preferences Contract with EMR vendor will need to be staged for growth EMR will support P4P reimbursement criteria Reliability is key a lot of dissatisfaction with current systems and vendor support Inefficiencies are prevalent in practices

19 Interview Themes Common systems (especially PPMS) is a huge benefit can draw from a larger pool of experienced staff Several practices are already looking for new systems New systems must be physician friendly and easy to deploy Physicians will need to overcome residual mistrust of BTMG from previous de-install of PPMS System needs to be underwritten by BTMG (hardware, software, communications) Must be a good deal (less cost and more efficient) and a it imperative that the benefits are clearly articulated for buy-in Data conversions from existing PPM systems will be needed Resistance to EMR from older physicians expected Resistance to PPMS from entrenched billing managers expected

20 Key Functional Priorities Based on the stakeholder interviews the following key functional priorities emerged: Billing & Reporting EDI billing Contractual variances Insurance follow-up Tracking status of payments Effective date for co-pay Bubble forms for charge capture Flexible A/R reporting Collections module Multiple payor types/ppo products Contact capitation Using claims data for clinical research and assist with disease mgmt Scheduling Flexible scheduling features Scanners for insurance cards Link with prior authorization Electronic Medical Record Results reporting Workflow (refills) eprescribing w/formulary Ease of charge capture Note entry Voice recognition Disease management Drug interactions Health maintenance Problem lists HEDIS measures Guidelines Clinical reporting, e.g. lipid values

21 Physician Practice Solutions Strategy System Selection

22 Internet Member view of clinical record Personal disease management Self help General Health Information Brown & Toland Medical Group Characteristics Patient Education Ancillary Services Lab Radiology Pharmacy PT Administration Eligibility Management Care Management Claims processing Capitation management General financials Decision support Case management Concurrent review Wellness management Preventive management Disease management Patient Intervention Patient Advocacy Customer service PCP assignment Demand management Credentialing Protocols Pathways Medical policies Practice guidelines Clinical decision support Alerts & Reminders Journals Medical Knowledge Population Management Outcomes Best practices Research Research & Education Medical Delivery Patient Access Primary care Specialty consulting Acute Post acute Scheduling Online Nurse advice Physician access eoffice Visits Rx Renewals Core Medical Group Characteristics Patient centric Accessible services Patient & MD is known to system Care & care management is coordinated across the continuum Clinical & administrative data is accessible enterprise-wide Consolidated financial processes Enterprise-wide reporting with feedback loops Support for wellness and knowledge transfer to patient

23 Vendor Evaluation Process Project Project Initiation Initiation & & Kick-off Kick-off Conduct Conduct Vendor Vendor Workshop Workshop Develop Develop & & Analyze Analyze Requirements Requirements Develop Develop Demo Demo Scenarios Scenarios & & Scoring Scoring Methodology Methodology Finalization Finalization and and Distribution Distribution of the RFP of the RFP Evaluate Evaluate RFP RFP Responses Responses & & Determine Determine Leading Leading Vendors Vendors Detail Detail Vendor Vendor Demos Demos & & Determine Determine Vendor Vendor Finalist(s) Finalist(s) Conduct Conduct Finalist(s) Finalist(s) Due Due Diligence Diligence (Site (Site Visit/ Visit/ Ref.Calls) Ref.Calls) Vendor Vendor of of Choice Choice Recommendations Recommendations Begin Begin Contract Contract Negotiations Negotiations Develop Develop Implementation Implementation Plan Plan Core Core Part Core Core Part Core Key Part = Participants Core = Core Team Approvals = Client = Narrowing Points Manage Manage Expectations Expectations and and Vendor Vendor Communications Communications

24 BTMG Guiding Principles Based on the stakeholder interviews the following guiding principles emerged: Focus Area Risk Technology Implementation/ Support Guiding Principle Good reputation for solid vendor support State-of of-the art software and forward-thinking company Stable company with solid track record Meets database platform standards Common (single) database between systems (PPMS/MCA/EMR) Enterprise master patient identification (EMPI) ability Lower cost of ownership supported through a browser-based based front end Minimize information technology infrastructure at individual physician offices Vendor independence through availability of client-based tools for customization Leverage internal IDX knowledge Ability to deploy EMR in modular manner to accommodate variability of use amongst practices

25 Technology & Vendor Options A: Single Vendor Solution PPMS/MCA/EMR Single patient-centric database B: Hybrid Solution multiple vendors IDX MCA Interfaced to PPMS/EMR Other Vendor PPMS/EMR Single patient-centric database C: Hybrid Solution aligned vendors IDX PPMS/MCA Single patient-centric database Allscripts EMR Interfaced to PPMS

26 Applications Suites Brown & Toland Solution Access Management Master Patient Index Scheduling Visit Management Eligibility Verification Referrals Ambulatory Payment Classification Patient Financials A Single Financial Solution Claims Editing Software Combined business Services EMR Charge Capture Clinical Results E-prescribing Scan Order Authorization Risk management Dictate Self-Service Web Transcribe BTMG will also provide sophisticated Portals Document Advance reporting Benefit systems for physician use Workflow Notice TECHNOLOGY FOUNDATION Delivers operational benefits across the organization

27 Physician Practice Solutions Strategy Implementation Overview

28 Implementation Imperatives Solidify Early Adopters Flexible Critical Path Resource Management Enterprise Alignment

29 Sharing Information A Major Decision Enterprise Model

30 Clinical Results Reporting November 1, 2004 Go Live LabCorp 320 of 700 Physician Agreements in place Next Steps Additional Training Sessions increase adoption Additional Lab Vendors Radiology Results

31 Clinical Results Reporting Lessons Learned 1 Physician : Staff Flexible Training Timetable & Approach HIPAA Privacy Regulations Lab Vendors Physician Offices Building Trust & Buy In

32 Full EMR Adoption Focused on early adopters Slow ramp up 25 Physicians by end of 2005 Build to core group over year period Use experience and success of early adopters to move late adopters

33 Full EMR Adoption Lessons Learned Demand greater than expected Larger groups appear to be early adopters although more interest than expected from solo practitioners Investment in experienced and focused deployment team has been invaluable in working through implementation issues and process changes Modular approach will facilitate adoption Physician champion in each office

34 Physician Practice Solutions Strategy In Summary

35 BTMG s IT Strategy Supports Key Business Drivers Known to BTMG throughout the enterprise Improve quality of care through patientcentric view of health record Patient Physicians Physician Services Strategy PPMS EMR Physicians have not invested heavily in technology Physicians have not recognized ROI with existing systems Physicians have not had solid, coordinated IT Support Improve practice s financial health through improved billing and reimbursements Strengthen ability to provide high quality care through the use of solid IT systems BTMG Need to recruit younger physicians Strengthen medical management Manage costs of care delivery through improved access to clinical data and use of best practices Recognize revenues from P4P through technology deployment Expand services to better meet business needs of BTMG physicians

36 Three-Step Approach Activities to Occur in Parallel Focus Groups Establish functional & technical focus groups to perform detail due diligence Provide education on the features/functions offered with PPMS & EMRs Conduct survey to determine key drivers for physicians Define key functional requirements and technical environment Define specific benefits to be achieved with the new software and BTMG s s services Due Diligence IDX / Allscripts to provide BTMG with formal proposals: To support proposed modules & implementation approach & timing Detail bid based on specific sizing & staging of roll-out out Conduct several reference calls to comparable vendor clients to discuss support, training, implementation and overall satisfaction. Implementation Planning & Contracting Develop overall cost of ownership and revenue model for software and services Refine implementation approach and roll-out out plans Determine key negotiating points and strategy Conduct negotiations

37 Minimize Risks Setting expectations is critical BTMG offering will need to be better and cheaper than what I have today Ownership of data (especially clinical data) may present concerns over loosing control of their practices EMR Adoption Older physician population may not embrace new clinical technologies Contracting for best price but unknown participation will be a challenge Clear requirement for modular implementation to address various levels of interest

38 Implementation Challenges Education is a MUST!!! Identifying a broad but focused group to drive implementation efforts will be critical Variability of practices will cause challenges with setup and maintenance of systems Process redesign will become a necessary component of improvements and may be resisted This will be more evident in EMR deployment Recognize and accommodate for go-live slow downs and reduced productivity

39 Nothing will ever be attempted if all possible objections must first be overcome. first be overcome. Samuel Johnson